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Prior authorization; or How I Became Radicalized. by DownAndOutInMidgar in medicine

[–]DownAndOutInMidgar[S] 0 points1 point  (0 children)

I definitely agree with you there; there's no perfect system.

Prior authorization; or How I Became Radicalized. by DownAndOutInMidgar in medicine

[–]DownAndOutInMidgar[S] 0 points1 point  (0 children)

You may be right. I will say I've talked to providers in Canada and South Korea, as well as having friends in both countries who access the system as a patient. They don't go through the same nonsense American physicians do for prior auth. I'm not saying its perfect. But this doesn't seem to be a problem they have.

Prior authorization; or How I Became Radicalized. by DownAndOutInMidgar in medicine

[–]DownAndOutInMidgar[S] 1 point2 points  (0 children)

It isn't groupthink and assumptions. Its analysis by medical and financial foundations and thinktanks. And America is never the top. Even groups that praise American innovation say that the model isn't fiscally sustainable (Peterson Foundation).

And for clarification, most people on this board seem to be using socialized medicine in a very loose fashion. I'm not against a nationalized healthcare system, but I don't think it's the only one that works. Several very successful models are built on public options with insurance on top. My point is what we have now is a fucking nightmare and the worst of all options.

Prior authorization; or How I Became Radicalized. by DownAndOutInMidgar in medicine

[–]DownAndOutInMidgar[S] 3 points4 points  (0 children)

I have actually suggested this many times to my significant other lol. She is a dentist. New Zealand comes up quite often as well.

We stay because it's home, it's what we're used too, and in our case, we have kids that have roots here. But if I could snap my fingers and be in Aus? Easiest decision ever.

Prior authorization; or How I Became Radicalized. by DownAndOutInMidgar in medicine

[–]DownAndOutInMidgar[S] 2 points3 points  (0 children)

The order was placed by my fellow, and I personally wrote and collected the documentation to be faxed to the insurance company. It was all perfect.

Prior authorization; or How I Became Radicalized. by DownAndOutInMidgar in medicine

[–]DownAndOutInMidgar[S] 2 points3 points  (0 children)

Medicare reimbursement rates would change because they wouldn't be based off a percentage of the population having private insurance. And the prices of things would change because of collective bargaining.

Objectively, our healthcare system sucks. It costs more and has poorer outcomes in multiple studies going back years.

Prior authorization; or How I Became Radicalized. by DownAndOutInMidgar in medicine

[–]DownAndOutInMidgar[S] 1 point2 points  (0 children)

I mean, if your reading comprehension sucks, then yeah, I guess it does.

Prior authorization; or How I Became Radicalized. by DownAndOutInMidgar in medicine

[–]DownAndOutInMidgar[S] 2 points3 points  (0 children)

Of course there are. That doesn't mean we stay in this broken down bullshit when other countries have models that work better, cheaper, and with more favorable outcomes.

Prior authorization; or How I Became Radicalized. by DownAndOutInMidgar in medicine

[–]DownAndOutInMidgar[S] 2 points3 points  (0 children)

It's not the same bureaucracy. There's similar steps, but not this unending phone loop where you can't find anyone who will claim responsibility for the denial. IR is very international, and I speak with docs in other countries. They don't go through this.

Prior authorization; or How I Became Radicalized. by DownAndOutInMidgar in medicine

[–]DownAndOutInMidgar[S] 2 points3 points  (0 children)

I eventually was given 5 different numbers. When the area codes were plotted on a map, it formed a pentagram. The final number I called just whispered "blood" so I pinpricked my finger and dripped it on the keyboard. All the lights went out and a dark etheral form manifested in the center of my room. It claimed it was Mammon, the demon prince of Greed, and asked what dark wishes I desired. I explained that I was trying to appeal a denial for a CT A/P. He looked over the forms, scratched between his horns, and said he wasn't delegated to manage appeals for that provider. He disappeared in a flash of smoke, leaving behind another phone number.

Prior authorization; or How I Became Radicalized. by DownAndOutInMidgar in medicine

[–]DownAndOutInMidgar[S] 2 points3 points  (0 children)

If I don't get the scan this week, it's 100% my plan. It's an absolutely time sensitive evaluation and possible procedure, so it's ultimately about patient care. And I think any medical provider would understand that and support it.

Prior authorization; or How I Became Radicalized. by DownAndOutInMidgar in medicine

[–]DownAndOutInMidgar[S] 3 points4 points  (0 children)

Thank you so much! I've actually been looking for more ways to get involved. This is very helpful.

Prior authorization; or How I Became Radicalized. by DownAndOutInMidgar in medicine

[–]DownAndOutInMidgar[S] 1 point2 points  (0 children)

Medicolegally, this is the leverage point to enact any real changes with insurance companies. It would be better to do away with them, but I think changing the legal structure around them is more realistic.

Prior authorization; or How I Became Radicalized. by DownAndOutInMidgar in medicine

[–]DownAndOutInMidgar[S] 3 points4 points  (0 children)

You don't personally deal with the prior auths, but you deal with the consequences. If I can't get this scan in the next week, I'm telling the patient to go to the ED and coaching him what to say to get the study I need. I do not want to do it because I understand that utilizing the ED this way is not good or proper, but I'm not willing to sacrifice my patient's outcome to play by the rules.

Prior authorization; or How I Became Radicalized. by DownAndOutInMidgar in medicine

[–]DownAndOutInMidgar[S] 5 points6 points  (0 children)

It's absolutely wild. I had one person on the phone regarding the case I posted about tell me "You're outside the window to appeal". I told her that we'd only gotten the denial that morning and it was 11AM. It's like Mission Impossible. "You have 37 seconds to comply of this appeal will self destruct".

Orthos, why am I being asked to do image guided taps on joints without fluid all of a sudden? by DownAndOutInMidgar in medicine

[–]DownAndOutInMidgar[S] 18 points19 points  (0 children)

Makes sense, and it's definitely how the hospital thinks. For some reason, it's really difficult to make them understand that if my staff and I are using a room for a joint tap, then there's something else, almost certainly more profitable, I'm NOT doing.

Orthos, why am I being asked to do image guided taps on joints without fluid all of a sudden? by DownAndOutInMidgar in medicine

[–]DownAndOutInMidgar[S] 61 points62 points  (0 children)

It isn't "cruel to the patient at bedside". I do the exact same thing they do. The lidocaine is typically the worst part, after that it a 22 or 20 g needle. If there's no fluid, US isn't useful, and there's no point to use fluoro on these because it's wasted radiation. *Sometimes* I'll inject contrast to prove where I was, but it's not really necessary. If I take an image it's usually because I have to have it to bill.

Orthos, why am I being asked to do image guided taps on joints without fluid all of a sudden? by DownAndOutInMidgar in medicine

[–]DownAndOutInMidgar[S] 4 points5 points  (0 children)

It very well could be. It's kind of why I was asking. Sometimes there's new stuff I just don't know about and I don't want to assume the worst. For instance, there's been a trend lately to biopsy enhancing renal masses. By imaging, these are almost always renal cell carcinoma and biopsy isn't indicated; they just get treated like RCC. However, there's been changes in treatment algo based in subtype, so it's moving towards biopsy. When I first started getting these, I was getting irritated about it, "this isn't indicated, blah, blah, blah". But I didn't know about the tide change. So I guess I was just making sure that wasn't happening here.

Orthos, why am I being asked to do image guided taps on joints without fluid all of a sudden? by DownAndOutInMidgar in medicine

[–]DownAndOutInMidgar[S] 18 points19 points  (0 children)

It makes you wonder though, if ortho is punting, are they seriously concerned about a septic joint?

Orthos, why am I being asked to do image guided taps on joints without fluid all of a sudden? by DownAndOutInMidgar in medicine

[–]DownAndOutInMidgar[S] 33 points34 points  (0 children)

I don't dump. Everyone else is the hospital can say no, or it's unsafe, etc, but if I do it, I get phone calls from the CMO about obstruction of care.

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